EAL

Child Nutrition: Food Security and Safety

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To assess, with the use of focus group discussions (FGD), food safety-related knowledge, perceptions, and practices of school-going adolescent girls in south India on topics such as:

Safe food
Qualities and indicators of safe food
Measures taken to ensure food safety when buying food
Sources of food safety information.

Inclusion Criteria:

Adolescent girls between the ages of 10 and 19 years
Enrolled in a government school and in grades six to 12
At least one participant from each grade was included in almost all focus groups
Occasionally helped their mothers with domestic chores such as cooking, serving food, cutting vegetables, getting groceries and taking care of their younger siblings.

Exclusion Criteria:

Not described.

Description of Study Protocol:

Recruitment

The four states in India were stratified into three broad population-based categories:
- Small: Less than 35 million
- Medium: 35 to 70 million
- Large: More than 70 million
They were further substratified into regions. Two districts were randomly selected from each region for a total of 16 districts.
Two government schools each were randomly selected per district from the list of government schools obtained from the respective district education departments
A total of 32 focus group discussions were conducted.

Design

Descriptive study.

Statistical Analysis

The recorded discussions were transcribed on the day after the discussion by the moderators using the notes taken by the observer to supplement the tape recordings, especially when more than one person spoke at the same time
The individual state reports were in turn compiled and similar findings were grouped under each theme with relevant comments.

Data Collection Summary:

Timing of Measurements

In preparation for the focus group discussions, a moderator guide containing questions on the following four topics was developed:
- Concept of safe food
- Qualities and indicators of safe food
- Measures taken to ensure food safety when buying food
- Previous exposure to food safety education
In all cases the adolescent girls were contacted through the schools after obtaining consent from the school administrators
Only girls who were willing to participate in the discussions were gathered on their school premises
The focus group discussions were conducted by the teams consisting of a moderator and a note taker, who were trained to conduct focus groups in a standardized way.
The focus group discussions were conducted in Telugu, Kannada, Tamil and Malayalam (the local languages). Each discussion lasted 45 minutes to one hour.
The sessions were recorded with an audiotape and dictaphone with the participants' permission.

Dependent Variables

Food safety knowledge, perceptions and practices:

Concept of safe food
Qualities and indicators of safe food
Measures taken to ensure food safety when buying food
Previous exposure to food safety education.

Independent Variables

School-going adolescent girls in South India.

Description of Actual Data Sample:

Initial N: 32 focus group discussions (six to 10 respondents in each group), total number of respondents not reported
Attrition (final N): 32 focus group discussions were conducted
Age: 10 to 19 years
Ethnicity: Indian
Location: Southern states of India, which include Andhra Pradesh, Tamil Nadu, Karnataka and Keraia.

Summary of Results:

Key Findings

Subjects confused the concept of nutrition with food safety
Food labels were checked but they were not aware of quality symbols like ISI (Bureau of Indian Standards), FPO (Fruit Products Order), and AGMARK (Agriculture Marking and Grading Act)
Subjects trusted more in brand names and expensive packaged foods
Subjects were less careful about snack food safety
When further probed about ensuring food safety, girls indicated that cooking with clean utensils, washing hands, using washed and fresh vegetables, storing in covered containers and serving food hot were important measures, as well as kitchen sanitation and personal hygiene
Receiving food safety information through school health education was preferred.

Author Conclusion:

Adolescent girls are not aware of food quality standards. Awareness needs to be raised on permitted food additives concerning which foods can use them. Children should be familiarized with quality symbols on food labels. Carrying out observational studies may give further insights into the food safety practices of the adolescents.

Funding Source:

Government:

Ministry of Health and Family Welfare, Government of India

Reviewer Comments:

Number of respondents in the focus group discussions was not described.
The group discussions have an inherent limitation in that the individuals may not come out with the most accurate picture of their food safety behaviors because there is always a possibility of reporting their best behavior so as to present themselves favorably to the others in the groups.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	Yes
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	Yes

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		???
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	No
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	Yes
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	N/A
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		Yes
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	Yes
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	Yes
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		???
	7.1.	Were primary and secondary endpoints described and relevant to the question?	N/A
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	N/A
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	???
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	No
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	No
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	No
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes